A comparison of urban and rural patients with chronic kidney disease referred to Inkosi Albert Luthuli Central Hospital in Durban, South Africa

Abstract

Background: The profiles of patients with chronic kidney disease (CKD) in rural areas have long been thought to differ from those of their urban counterparts. However, there have been few local studies to confirm this. Methods: A retrospective review was conducted to compare the characteristics of patients with CKD from rural and urban areas in the South African province of KwaZulu-Natal, who were referred to Inkosi Albert Luthuli Central Hospital (IALCH) from April 2012 to April 2013. Results: A total of 529 patients were included. The mean age of those from rural areas was lower than that of urban participants (40.6 vs. 53.4 years) and all these patients were Black. The rural patients had lower estimated glomerular filtration rates (mean values of 16.3 vs. 25.4 mL/min/1.73 m², P < 0.001). Regarding comorbidity, rural patients had higher rates of HIV infection (47.9% vs. 18.3%) but lower rates of hypertension (69.6% vs. 83.9%) and diabetes (20.3% vs. 54.1%) than the urban patients. Conclusions: Patients with CKD referred from rural areas differed significantly from their urban counterparts. Rural patients presented at a younger age, had a higher prevalence of HIV infection, and had more advanced kidney disease at referral. Poor socioeconomic circumstances limiting access to health care and less screening for CKD may have contributed to delayed referrals from rural areas.

Survival of South African patients on renal replacement therapy

“…A similar study from the Canadian Organ Replacement Registry reported higher overall mortality and deaths from infectious causes among HD patients who lived farther from their attending nephrologist [ 27 ]. Developing countries such as South Africa are likely to have a greater proportion of remote or rural patients requiring RRT [ 28 ]. A recent study comparing rural and urban South African CKD patients attending a tertiary hospital in the province of KwaZulu-Natal found that rural patients presented with more advanced renal disease and had higher rates of HIV infection [ 28 ].…”

“…Developing countries such as South Africa are likely to have a greater proportion of remote or rural patients requiring RRT [ 28 ]. A recent study comparing rural and urban South African CKD patients attending a tertiary hospital in the province of KwaZulu-Natal found that rural patients presented with more advanced renal disease and had higher rates of HIV infection [ 28 ]. Another South African study, at a private–public dialysis centre in Limpopo, found rural dwelling to be associated with higher all-cause mortality in patients treated with continuous ambulatory peritoneal dialysis [ 29 ].…”

Prevalence of impaired renal function among rural and urban populations: findings of a cross-sectional study in Malawi

“…However, current knowledge about the prevalence of CKD and renal disease in Malawi, as in most sSA countries, is scarce 9 . Published data on CKD have been based on opportunistic sampling, involving people seeking medical care, or of urban populations, who have a different epidemiological profile from the rural majority 6, 10 . It is thought that glomerulonephritis and CKD of unknown origin (CKDu), might account for a larger proportion of the total CKD burden in rural or disadvantaged populations, whilst hypertension and diabetes are more prevalent in urban areas 3, 11 .…”